Medical Consent Form For Babysitter

Source: Intergroup s Family Health Source Consent for Medical and/or Emergency Treatment I, , hereby voluntarily consent to the rendering of such care, including diagnostic procedures, surgical and medical treatment and blood transfusions, by medical doctors, hospitals or their authorized designees, as may in their professional judgement be necessary to provide for the medical, surgical or emergency care of my .. Date Signature of Legal Guardian Dentist Witness Address Name Address Phone Name of dependent Phone Allergies Health Insurance Carrier Health Insurance Policy and Group Personal Care Physician Date of last tetanus booster Address Medications dependent is taking Phone This is only an example of a consent form..